Accelerated Medical Practice Blog

As anyone in the coding world knows, modifiers are a critical component for accurate billing and maximum reimbursement. The notorious complexity of modifier rules creates considerable lag when it comes to the forms review and editing process. The questions below highlight key factors that must be taken into account when applying modifiers to procedures.  What does your practice management system allow or require? The first challenge for posting claims correctly to the practice management (PM) system...

On April 20, the Office of Inspector General (OIG) published a report explaining the use of the KX modifier. Seen most often with physical and occupational therapy billing, providers add a KX modifier to CPT® or HCPCS codes in order to show there is documentation on file justifying the need for that procedure, service, or supply, and the documentation meets Medicare coverage criteria. Of the claim samples reviewed, the OIG found less than 50 percent of...

When it comes to lab tests, one common area of missed revenue occurs with Rapid Flu tests. Doctors can purchase test kits for the Rapid Flu Test (87804) which tests for both A & B strains. Swabs are taken from the patient’s respiratory tract and the claim is coded based on the test results. If positive for 1 strain, bill 87804 once. If positive for both strains, bill 87804 on two separate line items with a...

In the AAPC article “Diagnosis Code Overload,” Jeremy Reimer discusses the problem of over-coding that sometimes appears when reviewing medical records. His example is a case where a patient had sustained injuries in a relatively minor motor vehicle accident.  The provider filed a claim with fourteen (14) diagnosis codes. Reimer brings to light several unspecified and ill-defined codes from category 780-799 that were inappropriately used to describe symptoms for a known medical condition. Physicians often end...

Many medical coding solutions and claim scrubbers promise a way to recover the savings from automating the charge entry process when using an EMR template. When looking for a solution, realize the ideal solution should not be an afterthought or one feature on a list of a hundred features. A coding solution should be carefully examined to determine: What types of rules does it include When are these rules applied Who reviews these errors and makes...

The American Academy of Professional Coders (AAPC) and the Centers for Medicare & Medicaid Services (CMS) have announced over 430 changes will be present in the 2012 HPCS II Code Books. Many medical practices can now begin to revise their encounter forms in preparation for 2012. 

White Plume Technologies stays abreast of ongoing changes in medical coding policies from customers. The new requirements for coding glaucoma will impact many of our Ophthalmology customers.